How to Diagnose Low Testosterone

Recognise The Symptoms, Recognise The Signs, Recognise What You Need To Do…

 

 

Definition


Testosterone Deficiency Syndrome (TDS) is a well-recognised medical condition.  Low testosterone can have a significant impact on both physical and psychological health, both short-term and long-term.  It is an under-recognised and under-diagnosed disease.  The Men’s Health Clinic is working hard to increase both awareness and understanding so that more men have safe and effective access to the care that they need.

According to the British Society for Sexual Medicine, the International Society for Sexual Medicine, the European Association of Urology and the International Society for Study of the Ageing Male, the agreed definition of Testosterone Deficiency Syndrome is:-

 

“A biochemical syndrome associated with advancing age and characterised by a deficiency in serum androgen levels with or without a decreased genomic sensitivity to androgens. It may result in significant alterations in the quality of life and adversely affect the function of multiple organ systems”.

 

Terms like the ‘Male Menopause’ and the ‘Andropause’ serve no other purpose than to mislead the general public and trivialise something that can have a significant impact on someone’s quality and quantity of life.  You wouldn’t deny a diabetic insulin, you wouldn’t show disdain for a hypothyroid patient requesting the most effective medications available and you most definitely wouldn’t trivialise the female menopause and live to tell the tale, you’d be lynched.  So why not apply the same standard to TDS?

 

Symptoms


The NHS does not routinely screen men for low testosterone.  We hear terms of prevention banded about, yet diagnosing and treating men with TDS does not seem particularly high on their priority list.  I could get on my soapbox, but I’ll refrain from making this political.  Suffice to say, to affect a positive change you, the individual, will need to take ownership of your own health and not rely on the NHS.  Not a bad thing in my opinion, take charge, take the lead, it’s your journey.

Surely it would make more sense to prevent low testosterone rather than allowing it to occur in the first place?  Surely there should be more awareness surrounding the potential negative impact that it can have on your well-being?  If you can recognise the symptoms, you may be able to prevent the disease.  Testosterone Replacement Therapy is a complex field that needs to be managed by a clinician who specialises in the field of male hormone replacement therapy.  There is no one-size-fits-all model, your testosterone and HCG need to be carefully titrated to meet your individual requirements, based on your genetics, physiology and utilisation.  Add to the mix the fact that your physiology and utilisation changes with time, you can start to appreciate that you will be working with me in helping you not only achieve hormonal optimisation, but also to keep it.

I would urge all men over the age of 18 to have a yearly total testosterone test.  That way you can identify a trend and look for causation.  It’s important to be the master of your own destiny, if you sit back and expect the world to come to you due to a sense of entitlement, then you’re in trouble.  Actions have consequences, it’s just a shame that we may not have fully appreciated what those consequences were until it was too late.  I’m not one for regrets, so there’s no point dwelling.  I wonder what we would tell our younger selves if we could go back, knowing what we know now, would you change a thing?

The following chart depicts the commonest presenting symptoms of TDS according to members of the closed Facebook group TRT in the UK.  These are discussed in more detail in The Benefits of TRT.

 

 

Once you’ve identified that there is a potential issue, you need to seek a diagnosis, look for potentially reversible causes and exclude any other pathologies that may worsen or mimic the symptoms of low testosterone.

If you would like to have a thorough diagnostic screen, I would recommend the ‘TRT Check Plus’ blood test from Medichecks (a link can be found on the Online Blood Tests page of our website).  It covers all of the necessary blood tests needed to diagnose TDS and safely commence treatment.  You should ideally be fasted and have the blood sample taken between 08:00 – 11:00 for accuracy.

 

Blood Results


The European Association of Urology (EAU), International Society for Sexual Medicine (ISSM) and BSSM guidelines all suggest that a level of:

  • Total testosterone of <8 nmol/L or free testosterone of <180 pmol/L (based on two separate 08:00-11:00 morning blood samples) requires testosterone therapy.
  • Total testosterone of >12 nmol/L or free testosterone of >225 pmol/L does not require testosterone therapy.

It’s important and rather revealing to note that the reference range is irrespective of age.  We are aware that testosterone drops with age, you’re supposed to make way for the next generation.  From a biological perspective, you’re wasting oxygen living past 50!  The issue is, you cannot apply the same standard to an 18-year-old as you do to a 65 year old.  At The Men’s Health Clinic, we treat you, not the numbers.

TRT is not a supplement, it is a medical therapy, it’s a long-term medical therapy.  In order to safely and effectively be prescribed testosterone and HCG you need regular blood tests, physical examinations and understanding of how involved you will need to be to help you achieve optimisation.  You and your clinician should only consider TRT once you’ve exhausted all other methods of increasing your testosterone to healthy levels.  TRT is good, in fact it can be life-changing, but it’s not as natural or as effective as your own body.  Eyes wide open.

 

BSSM Policy Statements on Testosterone Deficiency


  1. Testosterone deficiency is a well‐established, significant medical condition.
  2. Testosterone deficiency has well‐established symptoms.
  3. Testosterone therapy for men with testosterone deficiency is effective, rational and evidence based.
  4. There is no scientific basis for withholding testosterone therapy from men on the basis of age.
  5. Testosterone deficiency is associated with increased cardiovascular and all‐cause mortality.
  6. The evidence does not support an increased cardiovascular risk associated with testosterone therapy.
  7. There is no evidence that supports any increase in the risk of cancer of the prostate with testosterone replacement therapy.
  8. A major research initiative to explore the benefits of testosterone therapy in cardiometabolic disease is overdue.

 

Dr Robert Stevens MBChB MRCGP Dip.FIPT

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